Comparison of the Outcomes of Anterior Cervical Discectomy and Fusion and Cervical Disc Replacement for Cervical Disc Disease.

OBJECTIVE: To compare the radiological outcome and development of heterotopic ossification (HO) following single-segment anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) for cervical disc herniation and evaluate their impact on surgical success. STUDY DESIGN: Descriptive comparative study. Place and Duration of the Study: Neurosurgery Department at Bozyaka Education and Research Hospital, Izmir, Turkiye, between January 2020 and June 2022. METHODOLOGY: Patients aged 18-70 years with radicular neck pain unresponsive to conventional medical treatment and an MRI-confirmed diagnosis were included. Patients with osteoporosis (OP) were excluded. Patients were randomised into two treatment groups (ACDF and CDR) and stratified by age and symptom severity. Radiographic assessments and HO classification according to McAfee were performed. RESULTS: Among the included patients, 56 underwent ACDF and 45 underwent CDR. The mean patient age was 48.29 ± 9.530 and 41.84 ± 7.239 years in the ACDF and CDR groups, respectively (p <0.001). The postoperative disc height increased in both groups. The T1 slope was significantly higher preoperatively and in the early postoperative period in the CDR group than in the ACDF group (p = 0.001). HO was graded as 1, 2, 3, and 4 in 28 (27.7%), 6 (5.9%), 7 (6.9%), and 4 (3%) patients, respectively. CONCLUSION: ACDF and CDR provided similar improvements in radiological measurements and pain relief. Although both procedures significantly enhanced the patient's quality of life and disability scores, HO was more prevalent following CDR during long-term follow-up. KEY WORDS: Cervical disc replacement, Anterior cervical discectomy and fusion, Spinal surgery techniques, Heterotopic ossification.

Nocardia cyriacigeorgica brain abscess with Pemphigus vulgaris: first report.

Nocardia brain abscess is an uncommon but potentially life threatening opportunistic infection that generally occurs in immunocompromised patients. Nocardia cyriacigeorgica is a recently described species rarely reported as a cause of human disease. Pemphigus vulgaris is managed with immunosuppression. There have been four prior reports of brain abscess caused by Nocardia cyriacigeorgica.

Bilateral vertebral artery occlusion after traumatic complete disruption of the cervical spine associated with ankylosing spondylitis.

BACKGROUND: Bilateral vertebral artery occlusion is an uncommon and mortal injury that could be seen after high-energy traumas. We illustrate an extreme case of bilateral vertebral artery occlusion following traumatic cervical disruption with complete spinal cord injury in a patient with ankylosing spondylitis. A 49-year-old male was admitted to our emergency department after a motor vehicle accident. The American Spinal Injury Association Impairment Scale was a complete A grade. Computed tomography (CT) scan of the cervical region revealed complete disruption between C2 and C3 levels. Magnetic resonance imaging showed apparent compression and narrow calibration of the spinal cord. CT angiography demonstrated occlusion of the bilateral vertebral arteries. Because of the neurological status of the patient, extensive hematoma, and edema at the region, no surgical intervention could be planned. The patient died on the second day of his hospitalization. Only fourteen cases of bilateral vertebral artery occlusion following blunt cervical spine traumas have been reported to date. They have a possibility to cause vertebrobasilar ischemic events with a poor prognosis of morbidity and mortality. The gold standard of diagnosis is the catheter angiography, but also CT angiography has close sensitivity and specificity. The treatment strategies of vertebral artery occlusion are still unclear.

Efficiency of Distraction and Ligamentotaxis in Posterior Spinal Instrumentation of Thoracolumbar Retropulsed Fractures.

AIM: To compare the efficiency of distraction and ligamentotaxis in posterior spinal instrumentation of thoracolumbar retropulsed fractures according to the grade of spinal canal compression and fracture levels. MATERIAL AND METHODS: This study retrospectively reviewed 56 patients diagnosed with thoracolumbar fractures and significant fracture fragments retropulsed into the spinal canal who only underwent posterior instrumentation with distraction and ligamentotaxis, and compared groups according to the grade of spinal canal compression and fracture levels. The pre-and postoperative clinical outcomes were evaluated using Oswestry Disability Index and visual analog scale scores, and neuroimaging studies showed percentage of the spinal canal compression and fractured vertebral unit height. RESULTS: A total of 34 male (60.7%), and 22 female (39.3%) patients with a mean age of 46.25 years was enrolled in study. The percentage of spinal cord compression reduced significantly from 40.2% preoperatively to 26.8% postoperatively (+13.4%). The vertebral unit height increased significantly from 25.20 ± 3.2 mm to 31.85 ± 2.6 mm (+6.65 ± 2.7). The absolute spinal canal compression reduction was higher for grade II fractures (1/3 to 2/3 compression) (+13.3%) than for grade I fractures (up to 1/3) (+7.9%). Greater widening was observed at L1?L2 level (+16.2%) than at T11?T12 level (+10.2%). Statistically significant differences were found between the two groups according to the grade of canal compression and fracture levels in the mean preand postoperative spinal canal compression reduction. CONCLUSION: Indirect decompression techniques reduce retropulsed fragments, effectively improve the degree of spinal canal compression, and ensure safe laminectomy. The efficiency of distraction and ligamentotaxis after posterior spinal instrumentation correlated with the preoperative percentage of spinal canal compression and higher spinal canal area for fractures with a high preoperative stenosis.

Medulloblastoma in Adults: Surgical Outcomes and Survival - A Single Center Analysis of 16 Patients.

AIM: To look into the clinicopathological characteristics, surgical outcomes, and survival rates of adult patients with medulloblastoma. MATERIAL AND METHODS: Adult patients (age > 17 years) who had surgery in our clinic with the diagnosis of cerebellar mass between 2009 and 2015 and whose pathological diagnosis was medulloblastoma were examined. The study was carried out retrospectively by analyzing the clinicopathological data, surgical outcomes, and complications of the patients. In the postoperative and follow-up periods, contrast-enhanced cranial magnetic resonance imaging (MRI) was used to assess the presence of recurrence or residual disease. Moreover, the overall 5-year survival rates of the patients were evaluated. RESULTS: A total of 16 patients were diagnosed with medulloblastoma, with a mean age of 32.25 years old (age range 18?57 years). The tumor was found in the vermis in eight (50%) patients and the cerebellar hemispheres in the rest (50%) of them. Total excision was performed on 14 (87.5%) patients, near-total excision on 1 (6.25%) patient, and subtotal excision on 1 (6.25%) patient. The histopathological results were consistent with desmoplastic type medulloblastoma in nine (56.25%) patients, classical type in six (37.5%) patients, and anaplastic medulloblastoma in one (6.25%) patient. All patients received posterior fossa boost dose + craniospinal radiotherapy after the surgery. Recurrent lesions were found in six (40%) of the patients. A total of ten (62.5%) patients were still alive, and mortality rate was found to be 25% (4 patients) at 5 years. CONCLUSION: After 5 years, 10 of the 16 patients in our study were still alive. Lateral localization of the tumor, desmoplastic histologic variant, and total excision were all good prognostic indicators. Total excision is difficult in patients with brainstem invasion, and even if total excision is performed, the prognosis is poor.

A Comparison of the Surgical Outcomes of Laminoplasty and Laminectomy with Fusion in the Treatment of Multilevel Cervical Spondylotic Myelopathy: A Retrospective Cohort Study.

AIM: To compare the effectiveness of laminoplasty and laminectomy with fusion in the treatment of patients with cervical spondylotic myelopathy (CSM). MATERIAL AND METHODS: This study retrospectively reviewed 52 patients diagnosed with CSM who underwent either laminoplasty (LP group) or laminectomy with fusion (LF group). The preoperative and postoperative clinical outcomes were evaluated using Cobb?s angle of cervical lordosis, visual analogue scale (VAS) and modified Japanese Orthopaedic Association (mJOA) scores, and radiographs showing the antero-posterior diameter and area of the spinal canal. RESULTS: The mean age of the LP group was 60.12 years, while that of the LF group was 63.84 years. The pre- and postoperative mean mJOA scores were 11.46 ± 1.27 and 15.27 ± 0.87, respectively, in the LP group and 10.15 ± 1.89 and 14.92 ± 1.23, respectively, in the LF group. The pre- and postoperative Cobb angles were 16.22 ± 6.36° and 14.45 ± 4.50°, respectively, in the LP group and 14.39 ± 5.34° and 15.10 ± 6.21°, respectively, in the LF group. Recovery rates were 58.26% and 60.76% in the LP and LF groups, respectively. The mJOA scores, antero-posterior diameter and area improved significantly after surgery in both groups, while the Cobb angle increased in the LF group and decreased in the LP group. CONCLUSION: Laminoplasty and laminectomy with fusion improved neurological functions in patients diagnosed with CSM. Laminectomy with fusion should be the preferred choice when treating patients with preoperative axial pain as, despite expanding the spinal canal successfully, laminoplasty can also worsen the pain. However, laminectomy with fusion (except for OPLL) should not be the treatment of choice in a mobile spine as it severely restricts neck movements and impairs the Health-Related Quality of Life (HRQoL) of the patient. In the absence of kyphotic deformity, laminoplasty should be the preffered method for treatment.

Concomitant chronic subdural hematomas and arachnoid cysts in young adults.

Objective: This study aimed to evaluate the correlation between arachnoid cysts and chronic subdural hematomas in young adults. Methods: This retrospective study evaluated ten patients having concomitant chronic subdural hematomas and arachnoid cysts. Patients were evaluated with the data of age and gender, location of hematoma and arachnoid cyst, trauma history, symptoms at admission, maximum hematoma diameter, contiguity between arachnoid cyst and hematoma, and treatment  methods. Results: We treated 285 patients who were diagnosed with cSDH between January 2013 and December 2019. 22 patients were under the age of 40 years. Ten of them had both cSDH and arachnoid cysts. The mean age of patients was 24.8±3.9 years. Patients with only chronic subdural hematoma had higher mean age than the patients with arachnoid cyst-related chronic subdural hematoma. In four patients, the onset of chronic subdural hematoma was reported after arachnoid cyst diagnosis. Four of the patients did not have causative trauma history, and two patients suffered minor sports-related traumas. All patients had headache, and only two patients had hemiparesis. The location of arachnoid cysts were in the middle fossa in eight patients. All patients had chronic subdural hematomas on the ipsilateral side of arachnoid cyst. Four patients who had smaller than 10 mm maximal cSDH diameter underwent conservative management. They were followed by serial neuroimaging studies and it was noted that the hematoma disappered and the size of the arachnoid cysts decreased over time without any neurological complication. In six cases, craniotomy was required, and all recovered completely. cSDH did not recur during 5-60 months of follow-up period (median 12 months). Conclusions: It seems that presence of an arachnoid cyst in young adults is a predisposing factor for the formation of chronic subdural hematoma. Coincidentally diagnosed arachnoid cyst patients may be followed up with periodical clinical examinations and neuroimaging studies.

Guillain-Barre Syndrome After Craniocerebral Gunshot Injury: First Report.

BACKGROUND: Guillain-Barre syndrome (GBS) is a rare but serious disorder involving peripheral nerve inflammatory demyelination characterized by acute onset tetraparesis and areflexia. Generally, GBS is preceded by a bacterial or viral infection, and post-traumatic or postsurgical GBS is rarely seen. CASE DESCRIPTION: A 41-year-old man with severe craniocerebral gunshot injury and open depressed occipital bone fracture was operated urgently. Two weeks postoperatively, he suffered from sudden quadriparesis. He had flaccid paralysis of his bilateral muscle lower extremities (0/5), along with bilateral upper extremity weakness (2/5). CONCLUSIONS: We report the first case, to our knowledge, with post-traumatic GBS after craniocerebral gunshot injury. We want to indicate the possibility of post-traumatic GBS in cases of unexplained quadriparesis or quadriplegia after trauma or surgery.

The Impact of Propolis Factor Caffeic Acid Phenethyl-Ester on the Cerebral Vasospasm and Early Brain Damage in the Experimentally Induced Subarachnoid Hemorrhage on Rats.

OBJECTIVE: Caffeic acid phenethyl ester (CAPE), a phenolic compound, besides being 1 of the biologically active components of propolis, is a compound with antioxidant, antiinflammatory, antiviral, reperfusion damage prevention, immune stimulant, and carcinostatic, anticancer properties. The aim of this study was to investigate the possible effects of CAPE on cerebral vasospasm and early brain injury, which were experimentally administered intraperitoneally in rats with subarachnoid hemorrhage. METHODS: Thirty-two Wistar Albino rats weighing 200 to 300 g were used in our study. The rats divided into 3 groups: the control group (n = 10), subarachnoid hemorrhage group (n = 11), and subarachnoid hemorrhage + CAPE group (n = 11). These groups were evaluated according to the Ischemia index in hippocampal CA3 regions and the morphometric analysis of basilar artery diameter after being sacrificed at the end of 72nd hour. RESULTS: A significant difference was found between group 1 and group 2 for the CA-3 region, it was concluded that early brain damage occurred after subarachnoid hemorrhage. When the neuronal damage in CA-3 region was evaluated between group 2 and group 3, a statistically significant difference was found between the groups. There was a statistically significant difference between group 1 and group 3 in terms of ischemia detection. CONCLUSIONS: It was shown that CAPE has a preventive effect on early brain injury after subarachnoid hemorrhage and has a positive effect on reducing cerebral vasospasm. Our study is the first study in the literature showing that CAPE inhibits ischemic brain injury following subarachnoid hemorrhage.

Surgical management of Juxtafacet cysts in the lumbar spine.

INTRODUCTION: Juxtafacet cysts of the lumbar spine are extradural degenerative lesions associated with symptoms of lower back pain and radiculopathy. The aim of this study is to evaluate the efficacy of surgery and address controversial issues in the treatment of symptomatic juxta facet cysts in the Neurosurgical Department of our hospital and review of the literature. METHODS: Data from seven patients (age range 58-68 years, mean age 63 years) with low back and radicular leg pain due to a lumbar facet joint cyst were retrospectively analyzed. Demographic data, cyst level, presence of concominant local pathology, treatment and results of treatment were recorded. After surgery there was no case of a recurrent cyst during the follow-up period. The mean follow-up period of patients at the time of this study was 4 years. RESULTS: All patients had back pain, while five also experienced unilateral radicular leg pain and two had bilateral leg pain. Four patients had neurogenic claudication. MRI identified the cyst and highlighted underlying pathology in all cases. All patients underwent surgical cyst excision. Post-operatively, all patients showed a total resolution of symptoms with sustained benefit at final evaluation. CONCLUSION: Surgery is a safe and effective treatment for lumbar juxtafacet cysts.

The free neural grafting for recurrent nerve laceration Experimental study in rabbit.

AIM: The most dreaded complication of thyroidectomy is recurrent laryngeal nerve damage, which is most of the time hardly irreversible. In our experimental study we researched the use of free nerve grafts in the treatment of laryngeal nerve damage in rabbit. MATERIAL AND METHODS: There were three groups in our study. In the first group, the recurrent laryngeal nerve was severed and then a free nerve graft was interposed between the phrenic nerve and distal end of recurrent laryngeal nerve. In the second group, a defect in the continuity of the laryngeal nerve was created. The two ends of the nerve were joined together later by an interposed free nerve graft. In the third group, only a defect in the recurrent nerve was created without any attempt at uniting the ends together so that these latter subjects could be assigned as control group. In the evaluation process we performed laryngeal endoscopy, laryngeal EMG and histopathologic examination. RESULTS: On the 21. day of trial, in the first and second group vocal cord movements were detected on the laryngoscopy along with regeneration waves on EMG. In the third group there was no vocal cord movements on the side where a neural damage was created intentionally. On EMG there was degeneration waves as opposed to regeneration waves seen in the first and second groups. Histopathologic findings were similar. CONCLUSIONS: Recurrrent laryngeal nerve paralysis is an unwanted complication because it causes permenant sequela. Studies which intend to find a cure for this complication are increasing in number. We aim to find new approaches to cure patients suffering from this devastating complication as well. In our exprerimental study, vocal cord movements were reproduced without causing diaphragmatic paralysis. We believe the results of our study promise to relieve the suffering of patients. The results are encouraging. KEY WORDS: Muscle, Rat model, Reinnervation, Surgery.

Differences in individual susceptibility affect the development of trigeminal neuralgia.

Trigeminal neuralgia is a syndrome due to dysfunctional hyperactivity of the trigeminal nerve, and is characterized by a sudden, usually unilateral, recurrent lancinating pain arising from one or more divisions of the nerve. The most accepted pathogenetic mechanism for trigeminal neuralgia is compression of the nerve at its dorsal root entry zone or in its distal course. In this paper, we report four cases with trigeminal neuralgia due to an unknown mechanism after an intracranial intervention. The onset of trigeminal neuralgia after surgical interventions that are unrelated to the trigeminal nerve suggests that in patients with greater individual susceptibility, nerve contact with the vascular structure due to postoperative pressure and changes in cerebrospinal fluid flow may cause the onset of pain.

Neurotoxic effect of povidone-iodine on the rat spine using a laminectomy-durotomy model.

OBJECTIVE: The efficacy and safety of povidone-iodine in wound dressing and irrigation of some operative cavities were established by many in vitro and in vivo experimental reports and clinical series. However, its use in defective tissue in neural structures has not been confirmed yet. The aim of the present study was to histopathologically investigate its effect on neural tissues when applied on the upper side of defective dura. METHODS: Wistar rats were randomly divided into two experimental groups: control and povidone-iodine groups. In the control group, durotomy was performed following laminectomy, and the spinal cord was covered with a dry sponge. In the study group, the same procedure was performed, but open duras were covered with a sponge that had been wetted with 0.1 % povidone-iodine solution. Three weeks after surgery, all experimental animals were sacrificed, and histopathological evaluations were conducted. RESULTS: Myelin changes were absent or minimal in all cases of the control group but were present as markedly increased myelin degeneration in nearly all cases in the study group. Axonal degeneration and hypoxic neuronal damage were absent in the control group, whereas they were marked in half of the study group. No statistically significant differences were established in Schwann cell proliferation, venous congestion, and lymphocytic proliferation between the two groups. CONCLUSIONS: Based on the present study, 0.1 % povidone-iodine solution cannot be recommended for wound dressing for neural structures such as myelomeningocele cases because of possible damage to underlying neural tissues.